189
Au~ 19 10 12:46p Micke~ A. Steiman
^ \J U I I II 'U 1 VI I V '" V..J. 1.J 1\1Il
EOR INTERNAL USE ONLY
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Sue Rose ~
Date Recei~ed: 8-1 11.. 1/...fL
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845-229-6338
1'1\/\ I1V. u'tJ
p.9
I. UUL
2009.10-16 rCM
TOWN OF WAPPINGER
Application for Public Access to Records
FOIL REQUEST
FOR DEPARTMENT USE ONLY
Date Received by Dept ..!.' !:S., ~ 0
Department Head approval: ~
(init)
Date Applicant Contacted: ~ / t..1 1 J c!)
Date FoIL fulfilled or d
Closed by:
Date: L/JO Jl 0
Notes: ~# z.. 1'A~$~a~~~ -f/LI.~ WJ::J
cF I~ I C;. Cu>tt.<Vdd to It r ~"
Amount Due: Pages for a total oC$
o chock here if you are
requesting that the records
be mailed to this address.
Nam.:~~~~r!i~s~
Address: q \=b +- ~oQ
~ l2'::>o~ .
Agency or firm: Lo..~ ~~c..es ~~ ~~ ~. ~
Telephone ##: (~G1~ 2.2.5...- tD~cn FAX #; (~4s) 'Z1..9 - <o'?,.~~
Email address:
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SPECIFIC DESCRlPTION OF RECORD:
Any correspondence, notes, memoranda, documents and materials submitted by
or concerning the Foundation for the Chapel of Sacred Mirrors and/or Alex Grey.
FORMAT OF RECORD (if available)
1 request to be notified when I can COD'1fl to inspect the record.(s) described above
o I request copies of the records described above and agree: to pay the cost of such records 10
accordance with the fee schedule on the back oftbis application
o I request tha.t the records be scot via c-mllil to the address listed above
o I request that the records be faxed to the Dumber listed above